Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping automated endothelial keratoplasty: a meta-analysis
Aims This study aims to compare the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) in patients with corneal endothelial dysfunction due to Fuchs’ endothelial dystrophy or pseudophakic bullous kerato...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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BMJ Publishing Group
2023-12-01
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| Series: | BMJ Open Ophthalmology |
| Online Access: | https://bmjophth.bmj.com/content/8/1/e001397.full |
| _version_ | 1797367818332667904 |
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| author | Khitam Muhsen Tal Corina Sela Moti Iflah Alon Zahavi |
| author_facet | Khitam Muhsen Tal Corina Sela Moti Iflah Alon Zahavi |
| author_sort | Khitam Muhsen |
| collection | DOAJ |
| description | Aims This study aims to compare the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) in patients with corneal endothelial dysfunction due to Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy.Methods We conducted a meta-analysis using a literature search of Embase, PubMed, Cochrane CENTRAL, ClinicalTrials.gov and WHO ICTRP databases. We included randomised controlled trials (RCTs) and cohort studies that compared DMEK and UT-DSAEK (graft<130 µm), with a follow-up of ≥12 months, published until 20 February 2022. We used the Revised Cochrane risk-of-bias tool for RCTs and the Risk of Bias in Non-Randomised Studies-of Interventions system for cohort studies.Results Out of 144 records, 8 studies (3 RCTs, 2 fellow-eye studies and 3 cohort studies) were included, encompassing 376 eyes, (N=187 DMEK vs N=189 UT-DSAEK). The 12-month logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) was better post-DMEK (mean difference −0.06 (95% CI −0.10 to –0.02)), but with higher rebubbling risk: OR 2.76 (95% CI 1.46 to 5.22). Heterogeneity was significant I2=57%. Findings were consistent when excluding retrospective studies, including only studies with low risk of bias or RCTs only. An analysis of studies with mean DSAEK grafts <70 µm showed no significant difference in BCVA between the procedures. Publication bias was found in the BCVA analysis (Egger’s test p=0.023).Conclusions Post-DMEK BCVA is superior to post-UT-DSAEK when using <130 µm grafts. DSAEK grafts <70 µm may not significantly differ from DMEK. The higher risk of rebubbling with DMEK necessitates an appropriate selection of patients.PROSPERO registration number CRD42022340805. |
| first_indexed | 2024-03-08T17:22:34Z |
| format | Article |
| id | doaj.art-4542ad17321b492f887cd21f84be9dd5 |
| institution | Directory Open Access Journal |
| issn | 2397-3269 |
| language | English |
| last_indexed | 2024-03-08T17:22:34Z |
| publishDate | 2023-12-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Open Ophthalmology |
| spelling | doaj.art-4542ad17321b492f887cd21f84be9dd52024-01-03T04:00:09ZengBMJ Publishing GroupBMJ Open Ophthalmology2397-32692023-12-018110.1136/bmjophth-2023-001397Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping automated endothelial keratoplasty: a meta-analysisKhitam Muhsen0Tal Corina Sela1Moti Iflah2Alon Zahavi3Department of Epidemiology and Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelSchool of Public Health, Faculty of Medicine, Tel Aviv University, Tel Aviv, IsraelFaculty of Medicine, Tel Aviv University, Tel Aviv, IsraelFaculty of Medicine, Tel Aviv University, Tel Aviv, IsraelAims This study aims to compare the clinical outcome of Descemet membrane endothelial keratoplasty (DMEK) and ultrathin Descemet stripping automated endothelial keratoplasty (UT-DSAEK) in patients with corneal endothelial dysfunction due to Fuchs’ endothelial dystrophy or pseudophakic bullous keratopathy.Methods We conducted a meta-analysis using a literature search of Embase, PubMed, Cochrane CENTRAL, ClinicalTrials.gov and WHO ICTRP databases. We included randomised controlled trials (RCTs) and cohort studies that compared DMEK and UT-DSAEK (graft<130 µm), with a follow-up of ≥12 months, published until 20 February 2022. We used the Revised Cochrane risk-of-bias tool for RCTs and the Risk of Bias in Non-Randomised Studies-of Interventions system for cohort studies.Results Out of 144 records, 8 studies (3 RCTs, 2 fellow-eye studies and 3 cohort studies) were included, encompassing 376 eyes, (N=187 DMEK vs N=189 UT-DSAEK). The 12-month logarithm of the minimum angle of resolution best-corrected visual acuity (BCVA) was better post-DMEK (mean difference −0.06 (95% CI −0.10 to –0.02)), but with higher rebubbling risk: OR 2.76 (95% CI 1.46 to 5.22). Heterogeneity was significant I2=57%. Findings were consistent when excluding retrospective studies, including only studies with low risk of bias or RCTs only. An analysis of studies with mean DSAEK grafts <70 µm showed no significant difference in BCVA between the procedures. Publication bias was found in the BCVA analysis (Egger’s test p=0.023).Conclusions Post-DMEK BCVA is superior to post-UT-DSAEK when using <130 µm grafts. DSAEK grafts <70 µm may not significantly differ from DMEK. The higher risk of rebubbling with DMEK necessitates an appropriate selection of patients.PROSPERO registration number CRD42022340805.https://bmjophth.bmj.com/content/8/1/e001397.full |
| spellingShingle | Khitam Muhsen Tal Corina Sela Moti Iflah Alon Zahavi Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping automated endothelial keratoplasty: a meta-analysis BMJ Open Ophthalmology |
| title | Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping automated endothelial keratoplasty: a meta-analysis |
| title_full | Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping automated endothelial keratoplasty: a meta-analysis |
| title_fullStr | Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping automated endothelial keratoplasty: a meta-analysis |
| title_full_unstemmed | Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping automated endothelial keratoplasty: a meta-analysis |
| title_short | Descemet membrane endothelial keratoplasty compared with ultrathin Descemet stripping automated endothelial keratoplasty: a meta-analysis |
| title_sort | descemet membrane endothelial keratoplasty compared with ultrathin descemet stripping automated endothelial keratoplasty a meta analysis |
| url | https://bmjophth.bmj.com/content/8/1/e001397.full |
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